title: Portal vein embolization and application of autologous stem cells in patients with primary unresectable liver tumours.
abstract: BACKGROUND
  Only 15-20 % of patients with liver tumours can undergo radical surgery. Insufficient future liver remnant volume (FLRV) is one of the main causes of tumours unresectability. Portal vein embolization (PVE) together with administration of haematopoietic stem cells (HSC) may expand the operability of primary unresectable liver tumours.
  
  
  METHODS
  In this pilot study, the authors reported on five patients (1 hepatocellular carcinoma, 4 colorectal cancer metastases) with FLRV <30 %, who underwent PVE on the side of the tumour with a subsequent application of HSC to the non-embolized branch of portal vein.
  
  
  RESULTS
  PVE with HSC application was without any complications. In three patients, a sufficient increase of FLRV occurred within 2-4 weeks followed by a liver resection. All patients were between 5-12 months after the surgery in good condition; one of them was diagnosed with pulmonary metastasis after nine months that was successfully treated with laser metastasectomy. In one patient with hepatocellular carcinoma, an increase of FLRV and progression of the tumour in the liver occurred following the PVE with administration of HSC and the patient was treated only symptomatically. Despite an adequate increase of FLRV, severe intraabdominal adhesions hampered liver resection in one patient.
  
  
  CONCLUSIONS
  Combination of PVE with HSC administration appeared to be a promising method that stimulated growth of FLRV with a subsequent possibility of an early radical liver resection. The issue is a danger of tumour progression in the liver parenchyma following the PVE with HSC. The current randomized study should answer these questions (Tab. 1, Fig. 4, Ref. 38).
authors.affiliation: Charles University, Pilsen, Czech Republic.
authors.forename: V
authors.initials: V
authors.lastname: Treska
authors.forename: V
authors.initials: V
authors.lastname: Koza
authors.forename: D
authors.initials: D
authors.lastname: Lysak
authors.forename: F
authors.initials: F
authors.lastname: Slauf
authors.forename: H
authors.initials: H
authors.lastname: Mirka
authors.forename: A
authors.initials: A
authors.lastname: Sutnar
authors.forename: T
authors.initials: T
authors.lastname: Skalicky
authors.forename: J
authors.initials: J
authors.lastname: Fichtl
authors.forename: J
authors.initials: J
authors.lastname: Ferda
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011169:Portal Vein; D011446:Prospective Studies; D014182:Transplantation, Autologous